Citation Nr: 9804841
Decision Date: 02/18/98 Archive Date: 03/02/98
DOCKET NO. 97-17 120A ) DATE
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On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO) in
Columbia, South Carolina
THE ISSUES
1. Entitlement to service connection for a lung disorder.
2. Entitlement to service connection for a left knee
disorder.
REPRESENTATION
Appellant represented by: South Carolina Department of
Veterans Affairs
ATTORNEY FOR THE BOARD
P. Scott Craven, Associate Counsel
INTRODUCTION
The veteran had active duty from June 27, 1996 to August 23,
1996.
This case comes before the Board of Veterans’ Appeals (Board)
from a November 1996 decision of the RO.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends that her lung condition worsened in
service following a training exercise in a gas chamber. She
also claims that she has had bronchitis in the past but not
asthma.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1997), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that the preponderance of the
evidence is against the veteran’s claim for service
connection for a lung disorder. It is also the decision of
the Board that the preponderance of the evidence is for the
claim of service connection for left knee disability.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran’s appeal has been obtained.
2. The veteran is currently shown to have intermittent
shortness of breath due to hyperactive airway disease that is
exercise induced.
3. The veteran’s current lung disability unequivocally
existed prior to service and is not shown to have increased
in severity beyond normal progression during her brief period
of service.
4. It is likely that the veteran’s currently demonstrated
left knee patella femoral compression syndrome with
symptomatic subluxation of the patella had its clinical onset
during her period of military service.
CONCLUSIONS OF LAW
1. The veteran’s exercise induced intermittent shortness of
breath due to hyperactive airway disease which clearly and
unmistakably existed prior to service was not aggravated
thereby. 38 U.S.C.A. § 1110, 1131, 1153, 5107, 7104 (West
1991 & Supp. 1997); 38 C.F.R. § 3.303, 3.304, 3.306 (1997).
2. The veteran’s left knee patella femoral compression
syndrome with symptomatic subluxation of the patella is due
to injury which was incurred in service. 38 U.S.C.A. §§
1131, 5107 (West 1991 & Supp. 1997); 38 C.F.R. §§ 3.102,
3.303 (1997).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
I. Historical Background
A careful review of the service medical records shows that,
in December 1995, the veteran’s enlistment examination
reported that her lungs, chest and lower extremities were
clinically normal. The veteran noted that she had never had
asthma, shortness of breath or cramps in her legs. On July
14, 1996, the veteran reported that she tripped on a crack in
the sidewalk while running and suffered a left knee injury.
An examination of the knee revealed no effusion or patella
grinding. She was diagnosed with left knee strain and given
a knee immobilizer and crutches. On July 16, 1996, the
veteran complained of pain in her left knee. An examination
reported a full range of motion, active and passive, a
negative drawer sign and a negative McMurray’s sign. There
was no effusion, edema or laxity. The veteran was noted to
have patellar grind with no crepitation. The veteran was
diagnosed with resolving contusion of the left knee.
On July 30, 1996, the veteran complained of shortness of
breath while running during PT. It was reported that the
veteran had a history of shortness of breath on exertion that
existed prior to service that was confirmed by her mother.
The veteran was assessed with dyspnea on exertion with a
history that existed prior to service. On a report of
Entrance Physical Standards Board Proceedings, the veteran
was noted to have arrived at Fort Leonard Wood, Missouri on
June 27, 1996. She was reported to have complained of chest
tightness, shortness of breath, wheezing and coughing with
increased activity. Symptoms were noted to have begun within
two minutes after beginning increased activity and resolving
within 20 to 60 minutes after stopping. The veteran was
reported to have a positive medical history, which existed
prior to service, of the same chief complaints which had
never been diagnosed. The veteran’s history was noted to
have been confirmed per a phone conversation with her mother.
It was reported that multiple members of her family had had a
history of asthma. An examination revealed that her lungs
were clear to auscultation, bilaterally. The veteran was
diagnosed with dyspnea on exertion which existed prior to
service. It was recommended that the veteran be discharged
from the military and not be able to train due to this
condition that existed prior to service. These findings were
approved on August 8, 1996.
In September 1996, the veteran filed a claim for service
connection for a lung condition and left knee strain.
On VA examination in October 1996, the veteran reported that
she had a history of breathing problems that began when she
was in basic training. She indicated that she could run half
a mile before becoming severely short of breath with some
wheezing and coughing. The shortness of breath reportedly
lasted at least 10 to 15 minutes. The veteran noted that she
had had a full evaluation performed which demonstrated some
hyperactive airway problems. She also indicated that she had
pneumonia when she was in Missouri and had been hospitalized
for a week. She asserted that it took her about three weeks
for her to fully recover from this problem. The examination
reported that her respirations were regular and her lungs
were clear to auscultation on inspiration. No costovertebral
angle tenderness was noted. The veteran was assessed with
pneumonia. The examiner noted that he felt that her
intermittent shortness of breath to be hyperactive airway
disease which might be exercise induced.
On a VA joints examination in October 1996, the veteran
reported that she felt a “pop” in her left knee when she
slipped while running in the rain in service. She complained
of pain with prolonged standing or sport activities and that
her left knee would give way. The examination reported that
she had a positive patellar apprehension sign on the left
knee and positive femoral compression pain. She was noted to
have a full range of motion of the left knee. There was no
effusion or joint line tenderness. He had a negative pivot
shift and a negative McMurray’s sign. She was diagnosed with
patella femoral compression syndrome with symptomatic
subluxation of the patella.
II. Analysis
A. Lung Disability
Initially, the Board finds that the veteran’s claim is well
grounded within the meaning of 38 U.S.C.A. § 5107 (a) (West
1991 & Supp. 1997). That is, we find that she has presented
a claim which is not inherently implausible. See Murphy v.
Derwinski, 1 Vet.App. 78, 81 (1990). Furthermore, after
reviewing the record, we are satisfied that all relevant
facts have been properly developed. There is no indication
that there are unobtained records which are available and
which would aid a decision in this case. Accordingly, we
conclude that the record is complete and that there is no
further duty to assist the veteran in developing the claim,
as mandated by 38 U.S.C.A. § 5107 (a) (West 1991 & Supp.
1997).
Every veteran shall be taken to have been in sound condition
when examined, accepted, and enrolled for service, except as
to defects, infirmities or disorders noted at the time of the
examination, acceptance, and enrollment, or where clear and
unmistakable evidence demonstrates that the injury or disease
existed before acceptance and enrollment and was not
aggravated by such service. 38 U.S.C.A. § 1111 (West 1991 &
Supp. 1997); 38 C.F.R. § 3.304(b) (1997).
A preexisting injury or disease will be considered to have
been aggravated by active service where there is an increase
in disability during such service, unless there is a specific
finding that the increase in disability is due to the natural
progression of the disease. 38 U.S.C.A. § 1153 ( West 1991 &
Supp. 1997); 38 C.F.R. § 3.306(a) (1997).
Additionally, clear and unmistakable evidence (obvious or
manifest) is required to rebut the presumption of aggravation
where preservice disability underwent an increase in severity
during service; this includes medical facts and principles
which may be considered to determine whether the increase is
due to the natural progress of the disease. 38 C.F.R. §
3.306(b) (1997).
In December 1995, the veteran’s enlistment examination
reported that the veteran’s lungs and chest were clinically
normal. However, a careful review of the service medical
records shows, in July 1996, shortly after entering active
service, the veteran complained of shortness of breath while
running during PT. It was reported for clinical purposes at
that time that she had experienced a history of the same
complaints of shortness of breath on exertion prior to
service. Significantly, this was confirmed by her mother.
She was assessed by the treating personnel with dyspnea on
exertion with a history that existed prior to service. She
was subsequently assessed by a Medical Board with having
dyspnea on exertion which had existed prior to service, and
it was recommended that she cease training and be discharged
from service because of the pre-existing condition. The
recent VA examination assessed the veteran with intermittent
shortness of breath felt to be hyperactive airway disease and
might be exercise induced.
The Board finds that the medical evidence when considered in
its totality unequivocally establishes that the veteran’s
lung problem existed prior to her active service. In
addition, the Board finds that the pre-existing lung disorder
manifested by exercise induced shortness of breath due to
hyperactive airway disease is not shown to have undergone an
increase in severity beyond natural progression during that
brief period of active service. It is pertinent to note in
this regard that the service medical records are quite clear
in showing that her chief medical complaints demonstrated
shortly after beginning her military training had existed
prior to entering service. See Crowe v. Brown, 7 Vet. App.
238, 245-246 (1995); Akins v. Derwinski, 1 Vet. App. 228,
232(1991). While the veteran now contends that her lung
problems began in service, the medical records prepared
contemporaneously with her service do not support these
assertions. In addition, no competent evidence has been
submitted to support the veteran’s assertions that she
currently has lung disease which was incurred in or
aggravated by service.
In connection with the VA examination in October 1996, the
veteran recounted that she had had pneumonia in service and
was diagnosed, in part, with having pneumonia. However,
neither clinical findings reported in connection with the VA
examination, nor the service medical records confirm this
history or diagnosis. Evidence which is simply information
recorded by a medical examiner, unenhanced by any additional
medical comment by that examiner, does not constitute
competent medical evidence. Leshore v. Brown, 8 Vet.App.
406, 409 (1995). A medical professional is not competent to
opine as to matters outside the scope of his or her expertise
and a bare transcription of a lay history is not transformed
into competent medical evidence merely because the
transcriber happens to be a medical professional. Id. When
a medical opinion relies at least partially on the veteran’s
rendition of her own medical history, the Board is not bound
to accept the medical conclusions, as they have no greater
probative value than the facts alleged by the veteran. Swann
v. Brown, 5 Vet.App. 229, 233 (1993). See also Layno v.
Brown, 6 Vet.App. 465, 469 (1994) (in order for any testimony
to be probative of any fact, the witness must be competent to
testify as to the facts under consideration). Because the VA
examiner was likely relying on a recitation of the veteran’s
history from the veteran, there is no sufficient medical
evidence demonstrating that she has current disability due to
pneumonia which was incurred in or aggravated by service.
See Reonal v. Brown, 5 Vet.App. 458, 460 (1993).
Consequently, the Board finds that the preponderance of the
evidence establishes that the veteran's lung disorder clearly
and unmistakably existed prior to service and did not undergo
an increase in service beyond natural progress therein. In
reaching our decision, the Board has considered the doctrine
of giving the benefit of the doubt to the veteran under 38
U.S.C.A. § 5107 (West 1991 & Supp. 1997) and 38 C.F.R. §
3.102 (1997), but finds that the evidence is of such
approximate balance as to warrant its application.
Accordingly, service connection must be denied.
B. Left Knee Disability
Initially, we note that we have found that the veteran’s
claim is well grounded within the meaning of 38 U.S.C.A.
§ 5107(a) (West 1991 & Supp. 1997). That is, the Board finds
that she has presented a claim which is not inherently
implausible. See Murphy v. Derwinski, 1 Vet.App. 78, 81
(1990). Furthermore, after reviewing the record, we are
satisfied that all relevant facts have been properly
developed. The record is devoid of any indication that there
are other records available which might pertain to the issue
on appeal. No further assistance to the veteran is required
to comply with the duty to assist her, as mandated by
38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1997).
In the present case, the service medical records revealed
that, in July 1996, the veteran suffered a knee injury when
she tripped on a crack in the sidewalk while running. On
July 14, 1996, an examination revealed no effusion or
patellar grind and she was diagnosed with left knee strain.
On July 16, 1996, the veteran complained of pain in her left
knee. An examination revealed that she had patellar grind
with no crepitation and she was diagnosed with resolving
contusion of the left knee. The veteran filed her claim for
service connection for left knee strain in September 1996.
In October 1996, a VA joints examination revealed that the
veteran complained of pain in her left knee with prolonged
standing or with activity and that her left knee would “give
way.” The examination reported that she had a positive
patellar apprehension sign on the left knee and positive
compression pain. She was diagnosed with patella femoral
compression syndrome with symptomatic subluxation of the
patella. Hence, there is a continuity of symptomatology
indicating an apparent relationship between the veteran’s
current diagnosis and the injury in service.
Accordingly, the Board, based on its review of all the
relevant evidence in this matter, finds that the
preponderance of the evidence is for the claim. In light of
the foregoing, service connection is warranted.
ORDER
Service connection for a lung disorder is denied.
Service connection for a left knee patella femoral
compression syndrome with symptomatic subluxation of the
patella is granted.
STEPHEN L. WILKINS
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1997), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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